Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | ||
N | 225XP0200X | Occupational Therapist - Pediatrics | 8402 | CA |
NPI | 1427134972 |
---|---|
Provider Name | Amy Zipp |
First Address | Roseville, CA 95678-6193 |
Second Address | Roseville, CA 95678-6193 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 11/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1558953893 | TYPE 2 NPI (01) |